PANCREAS (ICD‐O‐3 C25)

Rules for Classification

The classification applies to carcinomas of the exocrine pancreas and pancreatic neuroendocrine tumours, including carcinoids. There should be histological or cytological confirmation of the disease.

Anatomical Subsites (Fig. 238)

C25.0	Head of pancreas
C25.1	Body of pancreas
C25.2	Tail of pancreas
C25.3	Pancreatic duct
C25.4	Islets of Langerhans (endocrine pancreas)

Notes

¹ Tumours of the head of the pancreas are those arising to the right of the left border of the superior mesenteric vein. The uncinate process is considered as part of the head.

² Tumours of the body are those arising between the left border of the superior mesenteric vein and the left border of the aorta.

³ Tumours of the tail are those arising between the left border of the aorta and the hilum of the spleen.

Schematic illustration of Head of pancreas, Body of pancreas and Tail of pancreas. — **Fig. 238**

Regional Lymph Nodes (Fig. 239)

Schematic illustration of the lymph nodes along the anterior and posterior pancreaticoduodenal vessels, the superior mesenteric vein and right lateral wall of the superior mesenteric artery, proximal mesenteric vessels, the common hepatic artery, coeliac axis, pyloric, infrapyloric, subpyloric vessels. — **Fig. 239**

Source: From F. Charles Brunicardi et al., *Schwartz’s Principles of Surgery*, 10th edition, 2015, McGraw Hill Education. © 2015 McGraw Hill Education

The regional lymph nodes for tumours in the head and neck of the pancreas are the lymph nodes along the anterior and posterior pancreaticoduodenal vessels, the superior mesenteric vein and right lateral wall of the superior mesenteric artery, proximal mesenteric vessels, the common hepatic artery, coeliac axis, pyloric, infrapyloric, subpyloric vessels, portal vein and common bile duct (not shown).

The regional lymph nodes for tumours in body and tail are the lymph nodes along the common hepatic artery, coeliac axis, splenic artery and splenic hilum, as well as retroperitoneal nodes and lateral aortic nodes.

TNM Clinical Classification

T – Primary Tumour

TX	Primary tumour cannot be assessed
T0	No evidence of primary tumour
Tis	Carcinoma in situ^*
T1	Tumour 2 cm or less in greatest dimension (Fig. 240)
	T1a	Tumour 0.5 cm or less in greatest dimension
	T1b	Tumour greater than 0.5 cm and no more than 1 cm in greatest dimension
	T1c	Tumour greater than 1 cm but no more than 2 cm in greatest dimension
T2	Tumour limited to pancreas, more than 2 cm but no more than 4 cm in greatest dimension (Fig. 240)
T3	Tumour limited to pancreas, more than 4 cm in greatest dimension (Fig. 241)
T4	Tumour involves coeliac axis, superior mesenteric artery and/or common hepatic artery (Fig. 242)

Note

^* Tis also includes the “PanIN‐III” classification.

Schematic illustration of tumour limited to pancreas, more than 2 cm but no more than 4 cm in greatest dimension. — **Fig. 240**

Schematic illustration of tumour limited to pancreas, more than 4 cm in greatest dimension. — **Fig. 241**

Schematic illustration of tumour involves coeliac axis, superior mesenteric artery and common hepatic artery. — **Fig. 242**

N – Regional Lymph Nodes

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N0	No regional lymph node metastasis
N1	Metastases in 1 to 3 regional lymph node(s) (Fig. 243)
N2	Metastases in 4 or more regional lymph nodes (Fig. 244)

Schematic illustration of Metastases in 1 to 3 regional lymph node. — **Fig. 243**

Schematic illustration of Metastases in 4 or more regional lymph nodes. — **Fig. 244**

M – Distant Metastasis

M0	No distant metastasis
M1	Distant metastasis

TNM Pathological Classification

The pT and pN categories correspond to the T and N categories.

pM1	Distant metastasis microscopically confirmed

Note

pM0 and pMX are not valid categories.

pN0

Histological examination of a regional lymphadenectomy specimen will ordinarily include 12 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.